Provider Demographics
NPI:1457730491
Name:HILL, GARY JONATHAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JONATHAN
Last Name:HILL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:664 WOODWARD AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3346
Mailing Address - Country:US
Mailing Address - Phone:314-973-8185
Mailing Address - Fax:
Practice Address - Street 1:17 FELTON PL STE A
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2153
Practice Address - Country:US
Practice Address - Phone:770-386-8996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003888103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical